Brain Stimulation Therapy Eases Tough-to-Treat Depression

THURSDAY, May 7 (HealthDay News) -- A technique called cortical brain stimulation improved symptoms and, in some cases, launched a full remission for people with major depression who had suffered for decades and who had failed multiple other treatments, researchers report.

"On average, these individuals had had depression for 27 years and had failed about 10 medication trials," said Dr. Emad Eskandar, lead author of a study presented this week at the annual meeting of the American Association of Neurological Surgeons (AANS), in San Diego. "Their current depressive episode had lasted an average of six years or longer. These were very, very sick people who were out of options."

Cortical stimulation, which involves placing electrodes near the surface of the brain (i.e., outside the lining of the brain but not actually in the brain), is potentially much less invasive than other therapies currently available.

Placement of the electrodes, which emit tiny, adjustable, electrical pulses that block dysfunctional activity in the brain, is done with minimally invasive surgery.

Brain stimulation tools may be emerging as the next wave of treatments for depression and other brain-related disorders, experts say.

In April, other researchers reported that deep brain stimulation -- where electrodes are inserted into specific brain areas -- cut symptoms of otherwise intractable depression by 50 percent for about half of those treated. The technique has also been successful in treating some cases of obsessive-compulsive disorder.

"Deep brain stimulation has been known to us. The first treatment for Parkinson's was done in 1987, and now it's gaining acceptance and more widespread use in psychiatry," said Dr. Vladan Novakovic, a psychiatrist with Maimonides Medical Center in New York City. "This is an emerging area of therapeutic neuromodulation. The brain is an electrical organ. There is a role for both chemical and electrical interventions in the treatment of brain-based disorders."

About one-fifth of people suffering from depression get no relief from psychotherapy and/or medication. About 70 percent of these "non-responders" can, however, benefit from electroconvulsive therapy. But many of these will later relapse, and there's still the group of individuals who fail all treatments.

For this trial, a dozen patients with refractory depression were randomly assigned to receive 8 weeks of cortical stimulation of the left dorsolateral prefrontal cortex (DLPFC) area of the brain, which appears to play a role in depression, or to get "sham" stimulation. Those receiving the sham treatment were then switched over to active therapy.

Stimulation was delivered via an investigational epidural cortical stimulation system, developed by Northstar Neuroscience, which funded the study. One of the authors is a consultant to the company.

On average, participants experienced an improvement of about 25 percent to 30 percent on different measures of both depression and quality of life.

Three people went into complete remission.

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